Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Tuesday, January 22, 2008

Scrub Club

I've just received an email from a designer, in New York City. She's addressing the issue of surgical scrubs and related attire, and asks for my input. (I love the unexpected connections that have arisen from blogging -- and state once again that it wasn't falling out of love that led to my abloggia. Or the current hypobloggia.) I imagine her contact was a scatter-shot towards all the surgeon-bloggers she could google; still, I'm both flattered and intrigued. And it seems a good topic for a post. Writing about a thing, after all, is the best way to figure out what one thinks.

Simple and entirely functional, scrubs are nonetheless among the most recognizable of uniforms, and make an easily understood statement of authority. And not a little edginess: "I work in an OR. I know things you don't, and never will (unless you read Surgeonsblog.)" Assuming the wearer is legit, which more and more is less and less the case.

I think there are phases of scrub-wearing: at first, as a student, you feel entirely a pretender. But you like it. If you select surgery as your future, when you wear them it feels like a commitment; before long, they become comfortable and practical, and wearing them is a matter of convenience (and saving money on laundry.) Somewhere along the line they become a badge of honor; and, eventually, it's all of those at once. I'm most aware of them, self-consciously and proudly, when I'm talking with family members immediately after completing surgery on their loved one. Which means, among other things, that one wants them neither dorky nor unclean.

In surgery, we wear gowns of some sort over the scrubs. Claims of imperviousness to the contrary, they often allow, uh, fluids to penetrate and stain our scrubs. (I wrote about some implications of that fact here.) And, permeable gowns or not, when an operation is fluidiferous the cuffs of one's pants and the shoes or the covers on them bear witness. It behooves, in other words, a scrub-survey before heading to the waiting room. (I know of one curmudgeonly and generally embittered surgeon who liked to talk to families still engowned -- the bloodier, the better.)

Having checked for nastiness and changed, if needed, into clean scrubs, I nearly always donned some sort of cover before going to the families. Since I eschewed a white coat until the latter part of practice, for many years that meant grabbing a cover gown: color-matched but generally untidy and sloppy-looking. It's only in retrospect that I see the get-up as unimpressive. Functional, efficient, but inelegant. I absolutely don't think that the clothes matter much; but when I began wearing a spiffy thigh-length white coat, I found I liked much better the appearance of a clean and pressed lab coat over scrubs. And I took off my surgical hat, too. I hate how I look in hats, and, having fairly long hair, I always wore a bouffant cap anyway. If there's anything to presenting a nice image, that pretty much tears it.

I worked in one surgery center that provided pink scrubs. Having no choice, I wore them.

And now, let me get to the central issue of scrub-wearing, as it applies to the male of the species. Here, I'll let you in on one of the best-kept secrets of the club. I'll begin with an aphorism known to males of any occupation: "No matter how you shake and dance, the last few drops go down your pants." I trust I needn't explain any further. Whatever else it might be, when wearing normal pants drippage isn't a, uh, cosmetic issue. But thin light scrub pants -- well, a spot is easily spotted. That may play into the controversy of tucking one's scrubs in or not; walking back into the OR having taken a break between cases, there may be, on occasion, reason for self-consciousness. Particularly if the stock of clean scrubs is low.

A friend -- my favorite anesthesiologist -- handled it best. Before returning after relieving himself, he'd put a drop of water on his fingertip, and dab it on his scrub pants, down at about knee level.

P.S: what the heck are those people in the title picture doing, anyway?

My son has had surgery a few times and the surgeons have always had scrubs on, for a consult, but when we had to see a plastic surgeon (mind you my son was about 10 months old) he was wearing probably the most expensive suit I've ever seen, what is it with plastic surgeons????

You have touched a nerve. As a female surgeon I detest having to wear mens pyjamas daily at work. My male surgical other half also suffers the consequences of inexpensive and poorly designed attire. Diagnosis "crotchilitis" aka jock itch stateside. This is due to a rather rough friction inducing inseam at the crotch which oftentimes sits around knee level in these monstrous shapeless tents. After a night on call this induces a characteristic pathognomic wide based gait and look of excruciating pain. Cured only be steroid creams.I have gone to the lengths of buying scrubs online from the states - much to the chagrin and undisguised envy of the nursing staff. Who do i think i am trying to look stylish at work! I would be happy to provide a female perspective if you designer wishes; unisex scrubs are my bete noir.I beg you to advise her thus;no unisex, slight bootcut, low rise, nothing shiny or nylon, not so many pockets (scrubs not combats) and fitted/wrap/tie at the waist of tops. Extra absorbance for the lead-wearing sweat-soaked orthopods and neuroscurgeons (and ideally fragranced) would be welcomedAny invention to eliminate "builders arse" or "ass crack" from the portering fraternity would be ingenious..And please remind her, all docs/surgeons are not men.

Looking forward to seeing your creations on the catwalks of Milan, modelled by your great self, of course!

Part of the problem in designing them is where they get worn. In the OR, we don't need the extra pockets (just one on the shirt for a pen to write orders and one on the pants for watch/wedding band). The PTs, OTs (my sister), and floor/ER nurses and personel may like (and need) more pockets.

I don't want low rise, but waist or slightly below waist with straight legs. And I am fond of blue for the OR. And I tuck my shirts, so my pager can sit at my waist.

When I was in plastic residency, we were not allowed to wear the scrubs out of the OR suite. Not even for a quick check on patients. Had to change back into our "nice clothes" and white coat.

Dr. Schwab, I'm assuming you've seen the fairly entertaining thread on this topic over at studentdoctor.net - check it out here: http://forums.studentdoctor.net/showthread.php?t=143702They had quite a discussion on the pee-spot issue. I liked the solution of the guy who stepped up close to the sink, disguising the errant drops with a splattering of water. Cleanliness is godliness, you know. ;)

HA!I think the models are in post-call delirium and they're just holding each other up.To confess, everytime I go pee when I wash my hands I always manage to splash a little extra on my pants...it camouflages quite nicely. I think that a well worn pair of OR scrubs is the most comfortable thing on earth. I wish I knew of a supplier that sold them online as it has become illegal to steal them at work.Hilarious post. Many thanks.

Gee Sid...I guess that anesthesiologist is the guy that goes to see a man about a horse too! ;)

I enjoyed the post - educational and entertaining!

I do have a question. I always assumed that each time a surgeon goes into the OR that he has put on a new/clean pair of scrubs. But if said scrubs didn't get contaminated with fluids, etc...do they just cover up what they were wearing with a gown and that is sterile enough? Is that gown all the barrier that is needed? And if they don't change scrubs each time...then how is it considered sterile after the doc has been walking all over the hospital in them and then back into the OR? They must change them...yes?*********************************This is off track a bit and I suppose could be another post, but how sterile is sterile in the OR? It seems you can't cover everything or housekeeping short being staffed could possibly take shortcuts, etc.

Also, while watching a surgery on the web...I noticed that there was other traffic that came into the OR to get things or for some reason and left. How common is it to have people other than the surgical team come into the OR during surgical prep/surgery?

And...I remember you saying you like to shave the pt yourself but forget why. I think it had something to do with less chance of infection.?

LOL, I enjoyed this post! I'm a seamstress and actually worked for a lady who ran a home business making scrubs (animalkingdomscrubs.com). I really enjoyed the job - could whip out a top in 7 minutes, pants in 11, jackets in 24. I had a good system going! Anyway, glad to see you're back. Its giving me a much needed break (or at least distraction) from morning sickness...(third kid - I always forget how bad it gets at first)

seaspray: good questions all. It might indeed be a good subject for a post. Meanwhile: One is supposed to change scrubs after leaving the OR suites and returning. I'd say not everyone does. If scrubs get sloshed, pretty much everyone changes them. Under most circumstances as long as the cover gowns and gloves are sterile -- which they are -- the cleanliness of the scrubs underneath isn't absolutely critical. They're clean, but never sterile, no matter what. On some occasions, when all hell is breaking loose, I've gowned and gloved over street clothes. No OR is absolutely sterile: as long as the tools and the gowns and gloves are, and the drapes, it seems to be enough. People do come and go into ORs frequently. In some -- in particularly when a prosthetic joint is being placed, very extraordinary precautions are taken: the room is specially cleaned, and closed down. No one enters when the operation is going on. The surgical team wears more extensive sterile coverings, including total headgear, sometimes with special re-breathers.

Why is it alright for people to come and go into ORs frequently? I am guessing out of necessity?

What if the person in the OR happens to be a fellow hospital employee on the table now with their Bajingoland on display? How much control does the pt's doc-surgeon have in keeping the traffic out or down for privacy concerns? Or does everyone the OR just figure the pt is out, will never know and so they don't worry about it?(Everyone is always more interested in all the details of a pt when they find out it is one of their own vs a stranger)

seaspray: infections of a prosthesis are disastrous and extra precautions are taken to prevent it. Also, when there's a foreign body present (a prosthesis, etc) it's much harder to eradicate infection than when an infection occurs post op absent foreign material.

People come and go based on need: to provide a break to personnel (surgeon excepted), to bring something that's been requested -- an instrument, etc.

When it's hospital personnel on the table, sometimes extra privacy is requested: signs on the door, etc.

I had my first knee surgery done where I worked but after that I always opted to go where I wasn't known.

Now I am "considering" (because I like it a lot) going to the hospital I have been a pt in over these last couple of years. 7 times in OR with Bajingo and God knows what else, on display and who knows what breezy things I said? I have been saying it wouldn't bother me because I have been there and done that already and the barrier has been broken. And I am alright with working there even now. But i am starting to think that once working there the hospital is going to seem a lot smaller to me as I get to know people and the various areas they work in, which may cause me to be shy about having anything done there as a pt in the future and I do like that facility and my docs who are affiliated there. So...I need to rethink this whole thing.

I would still be ok in the doctors office and wouldn't give it a second thought because it is a controlled environment and really everyone there would not care. But in hospitals it's different -at least that has been my experience when one of our own becomes a pt.

I have been operating under the assumption that it was the fault of unisex scrubs, with their lower rise intended for men, that I expose my "coin slot" every time I bend over. It would be nice if we could get some non-unisex scrubs!

If I get mediums - I'm showing way too much curve, and the waist is huge. If I get larges - I look like I forgot to leave my sheet in the bed. Oh, and the tops - I'm only 5'2" - my cleavage is not intended for the OR! Can we get some more petites with some shape? I've tripped (thankfully not catastrophically) on the pants that drag (no matter what I do) about 5 inches onto the ground. Sigh.

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.